Benign Prostatic Hyperplasia - New Treatment - Introduction

The term “benign prostatic hyperplasia” (BPH) may be based on three diagnosis: microscopic detection of prostatic hyperplasia (benign proliferation of the stroma and epithelium based on pathologic specimens); palpable enlargement of the prostate, detected by clinical or US examination; or on the presence of lower urinary tract symptoms (LUTS), such as higher urinary frequency particularly at night (nocturia), decreased hesitant, interrupted urinary stream, urinary urgency and leaking. However, it is the clinical definition measured by the severity of the lower urinary tract symptoms and the bother they cause that are supposed to be diagnosed and treated.

Benign prostatic hyperplasia (BPH) has a high prevalence rate over 50% in men aged older than 50 years and increases with age and by the age of 80 years more than 90% have BPH. Medical therapy is a first line treatment option, is indicated for patients with moderate lower urinary symptoms. Minimally invasive treatments include interstitial laser ablation (ILA), transurethral microwave treatment (TUMT) and transurethral needle ablation (TUNA) were originally conceived as an attempt to offer equivalent efficacy without the burden and risk of operative morbidity. Prostatectomy may be performed through the urethra (TURP) if the prostate is smaller than 80 to 100cc or by open surgery if prostate is larger. Both are associated with high complications rate. None of the minimally invasive treatments has proven superior to TURP from a cost/benefit standpoint, and TURP remains the standard of effective treatment. Both medical and surgical treatment options for BPH are associated to high morbidity rates.

Therefore there is the need of innovative technologies to continue to improve outcomes and minimize patient discomfort and morbidity when managing BPH. Prostatic arterial embolization (PAE) for BPH has been shown to be safe and effective inducing prostatic volume reduction in animals and humans. Mauro reported that BPH might follow uterine artery embolization for fibroids ( ). This statement is based on therapeutic parallel between PAE and UAE because in both procedures the embolization leads to ischemia and shrinkage.

Situated in Lisbon, Saint Louis Hospital is a French hospital located downtown in Bairro Alto one of the eldest and historic parts of Lisbon.

Fig.1

Benign prostatic hyperplasia (BPH) is de most common benign tumor in men.

The prostate is a small gland in men, that is part of the reproductive system, with the size and shape of a walnut. It is situated deeply in the pelvis, below the bladder, in front of the rectum and below the pubic symphisis. I surrounds the initial part of the urethra, the tube that carries urine from the bladder through the penis.

It produce the spermatic fluid that is expelled during ejaculation and gives activator properties and morbidity to the spermatozoids.

The normal prostate in adult is usually 20 to 30 cc.

In adult age and older men the prostate increases in size in most men.

Benign Prostatic Hyperplasia (BPH) means that is “not cancer” and is due to abnormal cell growth. As a result, the prostate becomes enlarged and may squeeze the urethra and cause problems in passing urine. Sometimes men in their 40s may begin to have urinary symptoms, but in others symptoms will start much later in life. More than 50% of men in their 60s and most in their 70s and 80s will have symptoms of BPH.

Fig.2

More than 50% of men have microscopic evidence of BPH by de age of 60 years and more than 40% present with clinical manifestations. BPH is the main cause of lower urinary tract symptoms in old men and can be associated with sexual dysfunction. It can significantly impact the quality of life and can result in serious medical conditions such as acute urinary retention and urinary tract infections.

The embolizations of prostate and uterine fibroids as well as all intervention techniques are performed by the team of Interventional Radiology of St. Louis Hospital. His Chief is the pioneer of Interventional Radiology in Portugal that was introduced in 1980.

Is Catedratic Professor of Radiology at Faculty of Medical Sciences, New University in Lisbon.

Due to the small size and complex anatomy of prostatic vessels, an assistant professor of Anatomy belongs to the interventional team of Saint Louis Hospital, in which are also included an assistant professor of Radiology and assistant professor of Urology, all of them at Faculty of Medical Sciences, New University of Lisbon.

In collaboration with a distinguished urologist he performs the embolization as a routine procedure in symptomatic patients with indications for treatment. Even patients with urinary retention and bladder catheter can be treated with excellent results.

The procedure is performed under local anesthesia, without pain or other symptoms, with short hospitalization, immediate improvement and short recovery.

The excellence of the procedure is due to a multidisciplinary team in which composition there is an intervention radiologist, an anatomist and an urologist.

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Comentários: 4

  1. Sandra Cardoso says:

    Boa Tarde,

    Estou a escrever em nome do meu pai, Daniel Cardoso. Ele tem tido tres biopsias ao prostate nos ultimos anos por causa de ter um nivel do PSA alto. Mas, em todas as instancias, as biopsias nao acusaram celuluas malignas nenhumas. Continua a ter problemas urinar e toma medicamentos para controlar o prostate todos os dias.
    Neste momento, nos vivemos no Canada, mas esta previsto de visitar Portugal em Outubro deste ano e gustava de aproveitar em tentar ter uma consulta no vosso clinica.
    E possivel marcar uma consulta para Outubro? E se sim, qual sao as informacoes medicas que necesita que ele traga?
    Fico agradecida pela sua resposta que podem fazer para sandra.cardoso@gmail.com

    Atentamente,

    Sandra Cardoso
    +1 226 448 7903

  2. Aldo says:

    I had prostate artery embolization done on January 12 and it took a long time more then 3 hours it has been about 2 months since I had the procedure and my symptoms have improved a great deal I am now getting up only one time at night compare to 4-5 times before and the flow of the urine has increase the only thong that has not improved is my sexual functions on yout website you are pointing out that only a third of the patiens will improve the sexual function but I understand it is still to early.
    Thank you for your feed back
    Aldo

  3. Pina says:

    vai ser respondido por mail

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